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Recent Outcomes of Surgical Redo Aortic Valve Replacement in Prosthetic Valve Failure
No full textBackground As redo surgical aortic valve replacement (AVR) is relatively high risk, valve-in-valve transcatheter AVR has emerged as an alternative for failed prostheses. However, the majority of studies are outdated. This study assessed the current clinical outcomes of redo AVR. Methods and Results This study enrolled 324 patients who underwent redo AVR due to prosthetic valve failure from 2010 to 2021 in four tertiary centers. The primary outcome was operative mortality. The secondary outcomes were overall survival, cardiac death, and aortic valve-related events. Logistic regression analysis, clustered Cox proportional hazards models, and competing risk analysis were used to evaluate the independent risk factors. Redo AVR was performed in 242 patients without endocarditis and 82 patients with endocarditis. Overall operative mortality was 4.6% (15 deaths). Excluding patients with endocarditis, the operative mortality of redo AVR decreased to 2.5%. Multivariate analyses demonstrated that endocarditis (hazard ratio [HR]: 3.990, p = 0.014), longer cardiopulmonary bypass time (HR: 1.006, p = 0.037), and lower left ventricular ejection fraction (LVEF) (HR: 0.956, p = 0.034) were risk factors of operative mortality. Endocarditis and lower LVEF were independent predictors of overall survival. Conclusion The relatively high risk of redo AVR was due to reoperation for prosthetic valve endocarditis. The outcomes of redo AVR for nonendocarditis are excellent. Our findings suggest that patients without endocarditis, especially with acceptable LVEF, can be treated safely with redo AVR.Y
Enhanced adhesion in PTFE-based dry electrodes with hydrogen bonding co-binder integration for advanced lithium-ion batteries
No full textAs the demand for sustainable energy solutions grows, dry electrode manufacturing processes have gained attention for their energy efficiency and elimination of harmful solvents compared to conventional methods. However, polytetrafluoroethylene (PTFE), a widely used binder in dry electrodes, suffers from poor adhesion to current collectors, resulting in high contact resistance and rapid capacity degradation. To address these limitations, this study introduces polyacrylic acid (PAA) as a hydrogen-bonding co-binder. The combination of PAA and PTFE significantly enhanced adhesion strength (40.0 gf center dot 20 mm-1 compared to near-zero for PTFE alone) and reduced interfacial resistance, ensuring stable electrode performance. Electrochemical evaluations demonstrated that PAA/PTFE electrodes exhibit superior rate capability and cycling stability. In full-cells, the PAA/PTFE binder system achieved an initial discharge capacity of 197.9 mAh center dot g-1 at 0.1C and a capacity retention of 82.2 % after 300 cycles at 1C, outperforming conventional PTFE-based systems (63.5 %). Furthermore, the improved cohesion within the electrode structure and enhanced wettability with the electrolyte contributed to the superior performance. These findings highlight the potential of PAA/PTFE as a scalable and sustainable solution for advancing dry electrode technologies, paving the way for efficient and eco-friendly lithium-ion battery production.N
First-Line Tislelizumab Plus Chemotherapy for Advanced Gastric Cancer with Programmed Death-Ligand 1 Expression ≥ 1%: A Retrospective Analysis of RATIONALE-305
No full textIntroduction Tislelizumab plus investigator-chosen chemotherapy (ICC) demonstrated a statistically significant improvement in overall survival (OS) versus placebo plus ICC in RATIONALE-305 in patients with locally advanced unresectable or metastatic human epidermal growth factor receptor 2 (HER2)-negative gastric cancer/gastroesophageal junction cancer (GC/GEJC) in the intent-to-treat population and in patients with programmed death-ligand 1 (PD-L1) Tumor Area Positivity (TAP) score >= 5%. The United States Food and Drug Administration Oncologic Drugs Advisory Committee voted (September 2024) against first-line treatment with programmed cell death protein-1 inhibitors in this setting in patients with a PD-L1 combined positive score < 1 or TAP score < 1%, due to an unfavorable benefit-risk profile. Thus, we retrospectively analyzed data from RATIONALE-305 in patients with a PD-L1 TAP score >= 1%. Methods Adult patients with locally advanced unresectable or metastatic HER2-negative GC/GEJC were randomized to tislelizumab 200 mg or placebo with ICC every 3 weeks. Efficacy and safety outcomes of tislelizumab plus ICC versus placebo plus ICC were retrospectively assessed in those with a PD-L1 TAP score >= 1%. Results At the final analysis cutoff (February 28, 2023), 432 patients received tislelizumab plus ICC and 453 received placebo plus ICC, and had a PD-L1 TAP score >= 1%. Clinically meaningful improvements to OS were observed with tislelizumab plus ICC compared with placebo plus ICC [15.0 months (95% confidence interval [CI] 13.3-16.7) vs. 12.8 months (95% CI 12.1-14.1), respectively; stratified hazard ratio 0.77 (95% CI 0.67-0.90)]. Progression-free survival, overall response rate, duration of response, and disease control rate, were also improved. OS improvements were maintained at a 3-year data cutoff (February 28, 2024). Tislelizumab plus ICC had an acceptable safety profile with no new safety signals. Conclusions Tislelizumab plus ICC is an effective and tolerable first-line treatment for patients with locally advanced unresectable or metastatic HER2-negative GC/GEJC with a PD-L1 TAP score >= 1%. Trial registration numberNCT03777657.Y
Optimal Cerebral Blood Flow Thresholds for Ischemic Core Estimation Using Computed Tomography Perfusion and Diffusion-Weighted Imaging
No full textObjective: Computed tomography perfusion (CTP) imaging is crucial in quantifying cerebral blood flow (CBF) and thereby making an endovascular treatment (EVT) after large vessel occlusion. However, CTP is prone to overestimating the ischemic core. We sought to delineate the optimal regional CBF (rCBF) thresholds of pre-EVT CTP. Methods: We collected acute ischemic stroke patients due to large vessel occlusion who achieved successful recanalization with baseline CTP, immediate post-EVT diffusion-weighted image (DWI) within 3 hours, and delayed post-EVT DWI between 24 and 196 hours. Core volumes estimated by CTP at various rCBF thresholds were validated against immediate and delayed DWI lesion volumes. Results: A total of 175 acute large vessel occlusion patients were included. Baseline CTP was taken in a median of 24 minutes (interquartile range [IQR] 21-31 minutes) after arrival; after the CTP, groin puncture in a median of 37 minutes (IQR 28-52 minutes), immediate post-EVT DWI scans in a median of 1.6 hours (IQR 0.8-2.1 hours), and delayed DWI scans in a median of 89 hours (IQR 69-106 hours). The correlations between the rCBF thresholds were the best at rCBF <22% for immediate DWI (0.64; 95% CI 0.55-0.73) and at rCBF <30% for delayed DWI (0.69; 95% CI 0.61-0.76). The interval between CTP and recanalization was inversely correlated with the overestimation of ischemic core volume compared with the subsequent DWI. Interpretation: Optimal rCBF thresholds for estimating ischemic core using CTP depend significantly on the timing of DWI post-EVT and CTP to recanalization delay. The optimal rCBF thresholds for ischemic core estimation may vary depending on the clinical setting. ANN NEUROL 2024N
Hyena: Optimizing Homomorphically Encrypted Convolution for Private CNN Inference
No full textPrivate inference using homomorphic encryption has gained a great attention to leverage powerful predictive models, e.g., deep convolutional neural networks (CNNs), in the area where data privacy is crucial, such as in healthcare or medical services. Processing convolution layers, however, occupies a huge portion (more than 85 %) of the total latency for private CNN inference. To solve this issue, this paper presents Hyena utilizing a novel homomorphic convolution algorithm that provides speedup, communication cost, and storage saving. We first note that padded convolution provides the advantage of model storage saving, but it does not support output channel packing, thereby increasing the amount of computation and communication. We address this limitation by proposing a novel plaintext multiplication algorithm using the Walsh-Hadamard matrix. Furthermore, we propose the optimization techniques to significantly reduce the latency of the proposed convolution by selecting the optimal encryption parameters and applying lazy reduction. Overall, Hyena achieves 1.6-3.8× speedup and reduces the weight storage by 2000-8000× compared to the conventional convolution. For deep CNNs like VGG-16, ResNet-20, and MobileNetV1 on ImageNet, Hyena reduces the end-to-end latency by 1.3-2.5×, the memory usage by 2.1-7.9× and communication cost by 1.4-1.5× compared to conventional method.N
Deep learning-based automatic segmentation of cerebral infarcts on diffusion MRI
No full textWe explored effects of (1) training with various sample sizes of multi-site vs. single-site training data, (2) cross-site domain adaptation, and (3) data sources and features on the performance of algorithms segmenting cerebral infarcts on Magnetic Resonance Imaging (MRI). We used 10,820 annotated diffusion-weighted images (DWIs) from 10 university hospitals. Algorithms based on 3D U-net were trained using progressively larger subsamples (ranging from 217 to 8661), while internal testing employed a distinct set of 2159 DWIs. External validation was conducted using three unrelated datasets (n = 2777, 50, and 250). For domain adaptation, we utilized 50 to 1000 subsamples from the 2777-image external target dataset. As the size of the multi-site training data increased from 217 to 1732, the Dice similarity coefficient (DSC) and average Hausdorff distance (AHD) improved from 0.58 to 0.65 and from 16.1 to 3.75 mm, respectively. Further increases in sample size to 4330 and 8661 led to marginal gains in DSC (to 0.68 and 0.70, respectively) and in AHD (to 2.92 and 1.73). Similar outcomes were observed in external testing. Notably, performance was relatively poor for segmenting brainstem or hyperacute (< 3 h) infarcts. Domain adaptation, even with a small subsample (n = 50) of external data, conditioned the algorithm trained with 217 images to perform comparably to an algorithm trained with 8661 images. In conclusion, the use of multi-site data (approximately 2000 DWIs) and domain adaptation significantly enhances the performance and generalizability of deep learning algorithms for infarct segmentation.Y
BRCA1/2 and Other Predisposition Genes in High-Risk Hormone Receptor+/Human Epidermal Growth Factor Receptor 2-Breast Cancer Treated with Endocrine Therapy with or Without Palbociclib: A Secondary PENELOPE-B Study Analysis
No full textPURPOSEThe PENELOPE-B trial (ClinicalTrials.gov identifier: NCT01864746) recruited patients with hormone receptor+/human epidermal growth factor receptor 2- early breast cancer without a pathological complete response after taxane-containing neoadjuvant chemotherapy and at a high risk of relapse. Patients were randomly assigned (1:1) to receive 13 cycles of palbociclib once daily or placebo on days 1-21 in a 28-day cycle in addition to endocrine therapy (ET). PENELOPE-B did not show improved invasive disease-free survival (iDFS) after adding palbociclib to ET. This retrospective analysis investigated the impact of germline pathogenic variant (PV) status of BRCA1/2 and non-BRCA1/2 cancer predisposition genes on the outcomes of PENELOPE-B trial patients.METHODSIn total, 445 patients were sampled following a case-cohort design and 442 were analyzed for germline PVs. Statistical analyses were performed for time-to-event end points (iDFS, distant disease-free survival [DDFS], and overall survival [OS]).RESULTSOf the 442 patients, 42 carried PVs in any cancer predisposition gene; 15 carried BRCA1/2 PVs. Irrespective of the treatment arms, PV status was not a prognostic factor. Regarding the treatment arms in BRCA1/2 PV carriers, numerically better 3-year outcomes were observed in the palbociclib arm (iDFS, 95%; DDFS, 95%; OS, 100%) than in the placebo arm (iDFS, 72.8%; DDFS, 72.8%; OS, 87.5%; hazard ratios palbociclib v placebo 0.349 [iDFS] and 0.562 [DDFS], not calculated for OS, too few events). In patients without BRCA1/2 PVs, the differences in 3-year outcomes were negligible. PVs in non-BRCA1/2 cancer predisposition genes did not influence the efficacy of palbociclib, although gene-specific effects could not be excluded.CONCLUSIONPatients with BRCA1/2 PVs had numerically better outcomes after palbociclib. However, the number of BRCA1/2 carriers was small. Larger randomized clinical trials should consider the PV status to further evaluate whether BRCA1/2 PV carriers benefit from cyclin-dependent kinase 4 and 6 inhibitor treatment.N
Vietnam in 2024: An Economy Navigating Smoothly Amid Political Turbulence
No full text2024년 베트남은 정치적 불확실성으로 구설에 올랐었다. 단 6개월 만에 당 총비서를 비롯한 정치국 직위 1/3 정도가 궐위와 보궐을 거쳤다. 권력투쟁이 격화하며 도이머이 이래 정치적 관행과 금기가 무너진 것처럼 보였다. 당장 정치 불안정과 정책 급변을 우려하는 목소리가 나왔다. 지금 되돌아보면 그 우려는 과장된 것이었다. 다른 분야에서 베트남은 기존의 관행을 유지했다. 외교 측면에서는 실리 위주의 대나무 외교를 계속하며 주요 중견국과 양자관계를 격상하고 몇몇 주변 강대국에서는 양허를 받아냈다. 경제 측면에서 수출과 투자의 호조를 바탕으로 연간 목표를 초과 달성했다. 외교와 경제에서 보여준 일관성에도 불구하고 정치는 여전히 유동적이다. 2024년 휩쓴 정치적 변화의 종착점이 무엇인지 여전히 내다보기 어렵다. 2025년 여름에는 제14차 당 대회 골격이 어느 정도 정해지고 럼 총비서의 '제도개혁' 성패가 드러난다. 그때쯤이면 먼지가 가라앉고 포스트 쫑 시대의 설계도가 보일 것이다. 그리고 거기서 드러날 정치경제적 배열이 베트남의 다음 6년을 규정할 것이다.N
A comparison of the outcomes of families with children aged less than 2 who received universal versus sustained nurse home visiting services in Korea: a cross-sectional study
No full textObjectives This study aimed to compare maternal outcomes and the home environment between non‑vulnerable families with children under 2 receiving universal home visiting services and vulnerable families receiving sustained home visiting services. Methods This study was conducted in Seoul, Korea, where the countrys first nurse‑led early childhood home visiting program was introduced. A total of 551 mother‑child dyads participated in cross‑sectional surveys conducted at various child ages (6±2 weeks, 6±1 months, 12±1 months, and 24±1 months). Universal home visiting services were provided within six weeks postpartum to non‑vulnerable families, while vulnerable families received sustained services consisting of 25 visits over 24 months. Maternal knowledge of sudden infant death syndrome (SIDS) and childcare, maternal distress, and the Korean Infant‑Toddler Home Observation for Measurement of Environment (K‑IT‑HOME) were assessed. Results Overall, the universal home visitation group demonstrated higher levels of maternal knowledge regarding SIDS and childcare compared to the sustained home visitation group (all p-values < 0.05), while the sustained home visitation group reported higher levels of maternal distress (p<0.0001). The total K‑IT‑HOME score was 1.47 points higher in the universal home visitation group than in the sustained home visitation group (p<0.0001). No significant differences were observed in the acceptance, organization, or involvement subscales of the K‑IT‑HOME (all p-values > 0.05). Conclusions This study demonstrated that disparities in maternal outcomes and home environments persisted in early childhood between the sustained and universal home visitation groups.N
P-Type Ternary Logic MOSFET With Tunable Middle State Using Bidirectional Threshold Switching
No full textA p-type ternary logic MOSFET (P-TMOS), which serves as the counterpart to a previously reported n-type ternary logic MOSFET (N-TMOS) but has been missing for the construction of a complementary standard ternary inverter, is demonstrated. The P-TMOS consists of a PMOS and an n-type threshold switch (TS) connected in series. While the PMOS determines the type of the ternary logic device, the TS, despite being an n-type device, provides both n-type and p-type characteristics, making it bidirectional with a tunable middle state in ternary logic. This tunable middle state is attractive for balancing noise margin and controlling power-delay product. By leveraging mature CMOS technology capable of large-scale fabrication, the Si-based P-TMOS facilitates the practical implementation of a ternary logic system.N